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Push to reduce unnecessary colonoscopies

A new Colonoscopy Clinical Care Standard has been launched by the Australian Commission on Safety and Quality in Health Care and will benefit millions of Australians seeking treatment.

It is the first nationally agreed standard of care for patients undergoing a colonoscopy.

The number of Australians who have a colonoscopy each year is approaching one million. Despite it being frequently performed, it is a complex medical procedure and should only be offered if the benefits outweigh the risks.

Undergoing the procedure unnecessarily doesn’t make sense and may extend the wait time for those who do need it, according to the new standard.

In launching the new standard in Brisbane during Australian Gastroenterology Week in September, the Commission said patients with a positive bowel cancer screening result should consult their general practitioner to discuss further investigation. In many cases this will be a colonoscopy.

The procedure examines the large bowel (colon) to diagnose and treat a range of bowel diseases including bowel cancer, the second most common cancer diagnosed in both men and women in Australia. Bowel cancer is expected to claim more than 4,000 lives in Australia in 2018.

The Commission’s Clinical Director, Professor Anne Duggan, said the new standard offers guidance to patients, clinicians and health services at each stage of a colonoscopy, with the goal of ensuring high-quality and timely colonoscopies for patients who need them. The standard will also help to reduce the number of unnecessary colonoscopies being carried out.

“The Commission’s Australian Atlas of Healthcare Variation 2015 found stark differences across the country in rates of colonoscopies being performed, with some areas having colonoscopy rates 30 times higher than others,” Professor Duggan said.

“Colonoscopy rates were significantly higher in capital cities and lower in remote areas. In major cities, rates were lower in areas of low socioeconomic status. The clinical care standard supports clinician certification and recertification as requirements for colonoscopy services, and will bring increased rigour to the procedure and shine a light on when and how these procedures are done.

“We asked experts in colonoscopy about how to look after people in the best possible way and used this information to develop guidelines for everyone involved."

Gastroenterological Society of Australia (GESA) spokesman Dr Iain Skinner is a colorectal surgeon and advanced colonoscopist who co-chaired the Commission’s working group that developed the new standard. He said the guidelines were much needed.

“The clinical care standard further enhances care, focusing on bowel preparation, sedation, the colonoscopy and recovery. The standard also clarifies appropriate use of the procedure based on evidence,” Dr Skinner said.

“This is an advanced procedure and we don’t want it being performed unnecessarily. Fewer unnecessary colonoscopies will free up access to more timely colonoscopies for those who are at moderate or high risk, such as those with a history of polyps or a significant family history of bowel cancer, or those who return a positive bowel screening test.”